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The challenge of connectivity in Texas, between libraries and between citizens, is complicated by the state's size—both geographic and demographic—and its diversity—ethnic, economic, and technological.

This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians’ experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform.

A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively.

Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations.

Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders’ decision-making about system reform.

This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.

This paper aims to investigate the current state, technological challenges, economic opportunities and future directions in the growing “indirect” hybrid manufacturing ecosystem, which integrates traditional metal casting with the production of tooling via additive manufacturing (AM) process including three-dimensional sand printing (3DSP) and printed wax patterns.

A survey was conducted among 100 participants from foundries and AM service providers across the USA to understand the current adoption of AM in metal casting as a function of engineering specifications, production demand, volume and cost metrics. In addition, current technological and logistical challenges that are encountered by the foundries are identified to gather insight into the future direction of this evolving supply chain.

One of the major findings from this study is that hard tooling costs (i.e. patterns/core boxes) are the greatest challenge in low volume production for foundries. Hence, AM and 3DSP offer the greatest cost-benefit for these low volume production runs as it does not require the need for hard tooling to produce much higher profit premium castings. It is evident that there are major opportunities for the casting supply chain to benefit from an advanced digital ecosystem that seamlessly integrates AM and 3DSP into foundry operations. The critical challenges for adoption of 3DSP in current foundry operations are categorized into as follows: capital cost of the equipment, which cannot be justified due to limited demand for 3DSP molds/cores by casting buyers, transportation of 3DSP molds and cores, access to 3DSP, limited knowledge of 3DSP, limitations in current design tools to integrate 3DSP design principles and long lead times to acquire 3DSP molds/cores.

Based on the findings of this study, indirect hybrid metal AM supply chains, i.e. 3DSP metal casting supply chains is proposed, as 3DSP replaces traditional mold-making in the sand casting process flow, no/limited additional costs and resources would be required for qualification and certification of the cast parts made from three-dimensional printed sand molds. Access to 3DSP resources can be addressed by establishing a robust 3DSP metal casting supply chain, which will also enable existing foundries to rapidly acquire new 3DSP-related knowledge.

This original survey from 100 small and medium enterprises including foundries and AM service providers suggests that establishing 3DSP hubs around original equipment manufacturers as a shared resource to produce molds and cores would be beneficial. This provides traditional foundries means to continue mass production of castings using existing hard tooling while integrating 3DSP for new complex low volume parts, replacement parts, legacy parts and prototyping.

Aarhus Kommunes Biblioteker (Teknisk Bibliotek), Ingerslevs Plads 7, Aarhus, Denmark. Representative: V. NEDERGAARD PEDERSEN (Librarian).

Index by subjects, compiled by K.G.B. Bakewell covering the following journals: Facilities Volumes 8‐17; Journal of Property Investment & Finance Volumes 8‐17; Property Management Volumes 8‐17; Structural Survey Volumes 8‐17.

Compiled by K.G.B. Bakewell covering the following journals published by MCB University Press: Facilities Volumes 8‐18; Journal of Property Investment & Finance Volumes 8‐18; Property Management Volumes 8‐18; Structural Survey Volumes 8‐18.

Compiled by K.G.B. Bakewell covering the following journals published by MCB University Press: Facilities Volumes 8‐17; Journal of Property Investment & Finance Volumes 8‐17; Property Management Volumes 8‐17; Structural Survey Volumes 8‐17.

Index by subjects, compiled by K.G.B. Bakewell covering the following journals: Facilities Volumes 8‐18; Journal of Property Investment & Finance Volumes 8‐18; Property Management Volumes 8‐18; Structural Survey Volumes 8‐18.